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2D ARNOLD DR - BPA-08-748 REMOVE/REPLACE PIPE Crry o - PLIDLic PR©fP K1A71FJIlI+'V GRISCWIt _ _ - �1:AYOt _ 12AW+txfIiF7Gt(aN.SYRk�T „ t;,S�h.1!sU14'10" . 't`:4s:9'1Q=7i5.9395>�1;NER710.95{6 _ AppI,YCATION' OR'TI tE R �AIit.RENOVA �l�f�'I'i12�� DEMOLITION«OR C OF<iJ E OR O C[JP IG`Y. FU, z M,£ T8'ii`ING ,'S- ijC��.OR BtJIL,_DIN� 1vQ SITE INFdRtUA ON © Cc rJ i'rop«ey bclocatett to IN eonservatloi,;AYea 1 Ohl , Hlstorlc Olatrlat Y1N. 4�`OUIiNER31�IP`iNFC'fR �10'N" s.t owner of Land .Name: Cq Address: 3�;COMPLE78 THr9 SEC dN FOR lNiriRktN;`EYt$ I q(1rONG9"�II�CY ' .Addition l ExTstin�. Renovation "NUMber of Storibs F2eitiovated' Change Ir " 1V®rw Deretolition Misting . . , ." . . Appoximawyearof ,Area.perfloor,-.(sty ft riavftps}" construction orrenovation of existing builoing t rW,Description of Proposed 1Nork: ©4,C c9 of J 1C 4v� f1 Q Mail Peltttit to: r t�n0�1 - ') 4 7 I CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT MAYOR tM WA904=W S7XW*SALEY.MAitAClepsa M 01970 TEL.975-745-9595 •FAst WO.740.9M Workers* Compensation Insurance AiSdavit: Builders/ContractorsMectrictans/Plumbers ADDUcaut Information Cnne:4rrsa-f:w a .illriftl#woi Please Print Legibly Name(Itaaieeasr �. P.O. Box 53 Address: Wonenam, MA. City/Statemp: Phone# _ - Are YAN as ampbyerT Check the appropriate boss 1.QT i am a employer with g 4. Q I am a 8men1 conissaw and I �Of project (required): employes(W and/or past-time).• have hhW the sub-contractan 6' 0 Now construction 2.❑ I am•sole proprietor err pumao- lined an the attached sheet t �. ❑Remodelia8 ship and have no employees These nib contncsoa have 8. 0 Demolition working for we in any capacity. workers'comp.insurance, g, 0 Building addition [No workers'comp.insurance 5. 0 We ace a corporation and its inquires.] officers have esacLed their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repair or additions myself.[No workers'comp. c. 152.j1(4),and we have ao Of in usince required.]t employes.[No workers' 13.142. 1 F� L ean*insutance mTdral �AaY ap6114nat ehaeks bra rl sent also 9111 not On Medan brow Amine 6* arwA wetkas - . .. - Haerowana vAd u 6e@ Mbrsaki"h.A1 wy a u doing as wok and elm hko-a�de�am wit aobotr tCoaantotow eW chick dds bat aawt attaehad on"Miaed Avot sbooft dw tam ub s Grew e .eamaetoe ®and IMtr roetaa• sinemp fkoftllaaSoon . /mw ow e>ployer that it providing workers'compeeso8oa&suroweejor my employes Below is the lnjo►mariow. /] Policy andJob sip Insurance Company Name: Policy#or Self-ins.Lie.#:_ G' (7 b(P C 0 /(�� ��. ` -(� Expiration Date: J ,� Job SiteAddren: 21 Loc)U b., City/State/Zip: l � � � olq-l(o Attach a copy of the workers'eampensatlon Polley declaration page(showing the policy number and es Failure ro secure covers as ppenalti chin} 8e required ender Section 23A of a 142 can lead to the imptuitioa otcrimiaa!penalties of a fine up to 51,500.00 and/or one-year imprisonment,As well as civil penalties in the form of a STOP WORK ORDER and A fine of up to 5250-W a day against the violator. Be advised that a copy of this statement may be forwarded to the OtRee of Investigations of the DIA for insurance coverage vaificsdon /do keribr cfAYA ender the pains and penalties ofper/ary that the information provided above h trite and cottons i Phone# 00c4al ase only, Do not write in thh area,ro be completed by city of town oQfelaL City or Town: Permit/Licease# Issuing Authority(circle one): 1. Board of Heiltb 2.Building Department 3.C11ylrown Clerk 4.Electrical Inspector A Plumbing Inspector 6.Other Contact Peron: Phone#: CITY OF SALEM PUBLIC PROPRERTY DEPARTNEM al++•+ 13t7.%Av :astfasar•iu:aLatays�t:wa+Za;.+r. Ttl:ya►f�ytlM �fists 9t1aJ�6�say Coastrucdott Debris Dhpotat Affidavit (required Aw all drealitioe and nssoto dws wont) Is 3WAnimm with the sixdt edidos otdw Stw Budding Cods; M CNIA soctios 111.! Debris,and dw govisions of MGL a 44 S Sdf g„ildi114 Prettit is tswwd with this condtios that the debris resuldng floe this wota shall be disposed of in s property licensed warm disposal facility as darted by%10L a tlLS15" rho debris will be uvnsporwd by: �S�,b� S -0-��--� laome�f -- rho kbds will be disposed of in : t u.rtw ur'ixtLty) rn n /� i 00-35,000 cf enclosed space - ,I (MGL C.112 SBOL) I{ 1A-masonry only - .'! 1G-4&2 Family Homes + Failure to possess a current edition of the . Massachusetts State Building Code is cause for revocation of this license, } DIG SAFE=CALL CENTER: (888).344.7233 � i OT L ✓'ate Larr+4na u a .;' € u, BOARDOfi>�� Lk71N�REGUeiT1O >Llcense- CONSTRUOTION SUPER—ISµO. MV,,. ' Number `CS - fps 897 z t� i Expres Ob/02/20Q7 Tr no. i21az7 �: ' `?` tea' •' Rest7lc��d 00�� TIMOTfY J FINN - r I' STONEHAM, •Co"rnmissl 1 PROPOSAL TD., INC. P.O. CONSTRUCTION SP CI �S UNL STONEHAM, MA 02180 Phone (781) 665-4410- Fax(781) 6644411 (.EN N OX BROAN-NUTONE A NORTEK COMPANY We hereby submit specifications and estimate for: �V_Y V 'e, c �. 2-?S Cl,`Cc. CVl Mflz� Sil1S�1LlI( �r IGt�C � 0 164 )n0x T, CIA � � C}�nc� � � � �5 _ IDS We propose hereby to furnish material and labor-complete in ae the above specifications for the sum of: AS ABOVE Payment to be made as follows: For special orders a 50% non-refundable deposit is required. For central vacuum and intercom installation,half is due upon rough-in and half is due upon completion. For all other work,payment is due upon job completion. Authorized Signature NOTE : All plumbing hook-ups, carpentry work& building permits are the responsibility of the job site general contractor or homeowner. Prices are effective for up to 3 months from date of proposal. Acceptance of proposal f.. Tb Won plew Tom^+ w wMWw on..Y,Mery od.n (vpad Yw.n w Ao 11y vwk u WdMd P Y�rW M (a,w�Wwd.Dora signarure If a� ep ed pl a sign and return. <lt eG�QLr� i S r �,Ian kJ�f✓ �1 �� -- What is.the current use ofthe Bu-ding? t Material of=Building? If dwelling,hny units? WiU the Building'Conferrr+-totaw? Astie'atcs?ti Architect's Name _ Address-and Phone _I L4 I C1 - Mechans-Name ^' ✓�,,. k' ,. mPJ�T.-O e— O Z l Z6 Address and Phone_I Construction Supervisors-license#_�S 5:-ki( HIC-Registration# i ' Go IL Li , Permit Fee Calculation EstlmatedCost of Project SJJ�Ss� - Permitfee i Estimated Cost X47/51000"Residential ----- - --' ---- --- ----- Estlrtrateil=EostX`�t'pfi`iQ00FEImmerC!ol An Additional $5.00`is added'as an, Adminiatretive charga. Make sureAhat all fields are properly and 160ibly written to:avoid delej s,in pr"3,!QO- ` The undersigned does hereby apply..for Building PermWto build tosthe above:stated, specifications. Signed under penalty ot'perjury X _ Date • sN All W. g g N � i