2 BORDER ST - BUILDING INSPECTION (004) EITY-OF -
i PUBLIC PROPERTY
DEPARTMEINT C
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.KAYO. 130 WASMNGroe,srnEEr. �.
S LEK uAu,.a{Lst„s oi97o
713-'978-74i95".FAx.97$.740.M6
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDS —'
1.0 SITE INFORMATION
Location Name.�/p �c� Building:
P7rty,A dress:
Property is located in a:Conservation Area YIN Historic District Y/N
{
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land C `
Name:
Address:
Telephone:
tl
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition P. New
Renovation Number of Stories
Change in Use
Demolition Approximate year of Area per floor (sf)construction or renovation
of existing buildingBrief Description of Proposed Work:
G
Mail Permit
_A
r ,
What is the current use of the Building?
Material of Building? If dweilin9.how many units?
Will the Building Conform to Law?
Asbestos?
Architect's Name
Address and Phone
Mechanic's Name ��
Address and Phone L HIC egistration#
Construction Supervisors Lice se#
Estimated Cost of Pr Permit Fes Calculation
fLj Estimated Cost X$7/51000 Residential
Permit Fee$ Estimated Cost X$1"$1000 Commercial
An Additional $5.0o is added as an
Administrative charge.
and legibly written to slays in processing.
Make sure that all fields are pro PerIY
for a Builds Penn bull o the a tated
The undersigned does hereby apply �
specifications. Signed under penalty of perju
Date
s , Qr y
rS
ppv-f ff66 g� �26
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sue- -�-- -
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Ed& Denise Mandonca
2 Boarder St
Salem, Ma 01970
Scone of work for three season room remodeling
Remove existing siding and interior finishes.
Install new windows. (In existing openings)
Install new entry door.
Insulate all walls, floors, and roof structure.
Upgrade all electric and add recessed lighting. (By electrician)
Install separate zone for forced hot water hearing (By plumber)
Install new interior finishes.
Install new exterior siding and trim.
{` Co- -F =�aoz Do0
O�I
74
BOARD OF BUILDING REGULATIONS`.,
License: CONSTRUCTION SUPERVISOR j
Number CSC 019575�
_ � Birthdate 08/1 B%1945: i
09/18/200'5. Tr:no: 1937
�� Res'aleroa oo �� ;I
ARTHUR J DU1Z JR kj
15A BEAVER
DANVERS, MA 01923I
Administrator, �
CITY OF SALEm
PUBLIC PROPERTY
DEPARTMENT
Maros 120 WaawawWW STUSr •I eu %USSACHUSUM01970
TIM MUS-9S"•FAX:9M7469616
Construction Debris Disposal Affidavit
(required for A demolition and rmwvadm work)
In amnlance with the six&edition of the State Building Code M CUR section I11.5
Debris,and the provisions of MGL c 40,S Sk
Building Permit 0 is issued with the condition that the debris resulting$om
this wort shall be disposed of in a properly licensed waste disposal Ateility as defined by MGL e
I 11.S 130A.
The debris will be transported by:
r
(east a[hssisr)
The debris will be disposed of in:
(sam.or faedity) �
(ad#m or Wdiry)
si or pit apt,
dare
FROM FAX NO. :17813425046 Oct. 17 2006 06:19PM P1
CITY OF SALEM
? PUBLIC PROPR.ERTX
DEPARTMENT
KOQEU w ONSCM
MAvoa
120 WAu0WON t""•UL M.hdAasac>�01970
Tsw 97L746.4f➢5 FAX:gWj&gM
Worltsrs'Compewatioa insursaee At>ddsvit: Builders/Contmton/Eleelridsms/Plainbers
Name(&uioeatitpr�n�aarrtnmvirbrly: �///u�Jl `7't'lpnrd<n� lnr7 s-l� Jos
Address: :, 6 U 7(V�16�4c_d"' .
eity/sffitt/Zip L_GI�v1 4�t��C� dlP�u 7>r 4 u;, Phone#:
A e yae an amplsyarr creek w --
� aDP�eM laoc
P I am A employer with 4. ❑I am a general contractor and I TYPO etpnJoet(requis%4;
mmployces(Adl ardlor part-time)-• have hired dw sub� 6. ❑New construction
2.® i am a Sole propeicau or per- listed on the attached shoot.a 7. ZRemoda
ijag
ship and have n o employees Thee sub-cooarmiosa have
wonting abr me in any capacity. Worla a $' 01 h•tioa
❑ We Sam a�P insurance.end nod i Q Building addition
NO Worlcen'comp,isatuwra 5. eaporsatm ts 9'
3.El J *utterer have cumiaed their 10.®lrlaeottcal xcpmm addisiono
or
No doing ad Wady tight ofeXemPt�Per MOL 11.0 Plumbing repairer or Wditiono
iaryranm t 1 cn� c. 152,¢1(4),and we have no I2.❑Raft
repaira
=Vloyeae.(No workers,
e .insrlfanpa required) 13.Q 0thar
•Aeywvaers as canons sera el mere etas s➢!oar w realm bra.oA¢wias mm..+arfrap''Nara.oa+.oa vas.abaft cis
+coneamaa tiro chant tda boa�aidao�ol a�arw r�A» e o�rWeorepy�eed a altidrvit
l aw.■aayrfpyu oipdb , ar<asn•°°°rp parlay
a provldLq sserters eaprpanrpaGvp lnsNreacajar my ear
phyNaa Below Is Girt parley omd fpd rpa
Insurance Company Nano: �L h ' C° n -
�t a H
PolicyllorSdf-bu.Gu.p• AwG7Di $��l
Jab Site Address: Gq-d�rS-- �{ Auadoe Daft- 3
Attacr•copy of tins Ciry/Suwzip: Scl n y.tq
werken'esuopewtiaa Pon"declaration Page(sko the Failure ro Secure coverage u 1OWied under Sectlon 25A of MOL e. 1 S2 can lead to rho'ap aa��r and
�p$at1M dooeJ�
Fine up ro S 1 300.00 and/or ooe yav ImPriaonmeat,as wen as civil O°P�don ofievl Panalga of a Of up er$2So.00 a day against dw vlolatnr. $o advised that a ea Of this s in the form of a STOP WORK ORDER and a he
Inveuigationa of the DIA fa bmurance coveraga veriflcetlan temtm may be forwarded to the OfY1ca of
!tier 11ero6J CW* Nadu dka !pa cad
S!enamrr ��il� praN4Gr ofPnlu7 t/iNt rAe fajormadon provided abaw b aart earl eorrpca
g `701
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oa1JA Do pod wrdar le fhbwerefo ba casrpWdbr U>ya:ority(etrele ont): - Permlt2keaaaltaltY 2.BailditltDepartmeat J,Cityrrown Clerk 4.Bleerrical raspectorS.Plumbnn ►ne s pecrorent Prose M