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53 BROAD STREET - BUILDING JACKET 9(tt�'.i�r,i Av �� a1em noapita Plans must be filed and approved by the Inspector before a permit will be granted. No /7 93 City of Salem Ward Is Property Located in the ,/ '� � Historical District? Yes_ No! �V Home Phone# "/ Is Property Located in a r J Conservation Area? Yes_ No r'��`cm.e�"�' Bus.Phone y APPLICATION FOR PERMIT TO CONSTRUCT POO DEC ND SHEDS Salem,Mass., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit to build according to the followi pecifi tions: Owner's name and address ��O Architect's name _ Mechanic's name and address C m 3 �6 �.•»� Swa.-r J D Location of building, No. What is the purpose of build' e e r Material of building? If a dwelling,for how man„ families? r Will the building conform to the requirements of the law? Estimated cost .�-o�.�L7 Contractors Lic. No. lCa h 2�. Signature of applicant Signed Under the Penalty of Perjury REMARKS J6. No.�V�—qj Ward v APPLICATION FOR PERMIT TO CONSTRUCT SWIMMING POOL Location PERMIT GRANTED A rove _ ilding 1 pector �15�95 MORTGAGE INSPECTION BAY STATE SURVEYING SERVICE INC. 234 CABOT ST., BEVERLY, MA. LOCATION LE/17 ___ �_I_JS, NOTES / • This is a Mortgage inspection survey and not SCALE � I�� =Z�0�77 FT. DATE � tj _� _� _ REFERENCE �C.�'%.�/Z47. PG.: 1$ an instrument survey,therefore this plot plan is for " mortgage inspection purposes only. • This survey is based on survey marks of others. To _�Q/!In1Q�11UE1�LT( _rIIO T _5_a'..- ._.._ • Bushes,shrubs, fences and tree lines do I hereby certify that I have examined the premises and that the not necessarily indicate property lines. building(s) shown on this plan are located on the ground as shown and that they conformed to the zoning setbacks of the • The building(s) are not located i . the special �7 flood hazard zone, as defined by H.U.D. G__ _GF_.-?`�} rJ'_I__-._.__. when constructed. lVe727, &1195� To ::�T 3sy Z-7 Z r2 y2 �+. #7.53 Ya MAKEPEACE qf� 41 Ac" in 1 0 j , � �� . � �_ -= - 1 I i i r� i \ -� . �, E _ yam L ;16 it g - 8 CITY OF SALEM - MASSACHUSETTS KEVIN T. DALY Legal Department LEONARD F. FEMINO City Solicitor 93 Washington Street Assistant City Solicitor 508-745-0500 Salem, Massachusetts 01970 508-921-1990 February 7 , 1990 William H. Munroe . Inspector of Buildings City of Salem OneSalemGreen _ Salem, MA 01970 CRE,?-. 5 —Stre�_gt ,_,S:aT.emdMassachusetts- Dear Mr . Munroe : Please be advised that I have examined various documentation including census records relative to the above-entitled real estate and it is my opinion that it was a lawful two-family dwelling prior to the adoption of the Zoning Ordinance in 1965 . In addition, the records of the Assessor ' s Office indicate this dwelling is currently assessed as a . two family. Accordingly, it is my opinion this dwelling should be afforded theprotectionof Section VIII ( E ) of the aforementioned . ordinance relative to nonconforming uses and this dwelling ' s current use as a two-family unit is permissible . Thank you for your 'attention to this matter. Very truly yours , 2 KEVGI DALY CITY SOLICITOR KTD/rmj rn < co an nA ® a,m r r. m 00 ,1 co c o v n m y C� CITY OF SALEl PUBLIC PROPERTY , DEPARTMENT KI.%RlFM.EY DRISCOLL MAYOR 120 WASHINGTON STREET•SALEK MA1SACHLSk1-IS 01970 TE.:978-74S-959S• FAx:978.740-9M 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: _ p� Building: Property Address:. Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: L/ f+ Address: s3 5� Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXIST Q BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition �y�v Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: 0,eMd1,)t0n p-L Cal_51"5 � ns ,// IVcrz/ �gf h",parrt nc ,� �; bo�� 3/9 1--elYo ►. /- r/ /9"*�'1S e-0a "'t Cetlr4 �Iae mot✓ L.v .�S Foots t; e ill.. - --_ ---_--_Mail Permit to: - _ What is the current use of the Buildi g7 �» , Material of Building? +�e0 If dwelling, how many units? — , Will the Building Conform to Law? Asbestos? Architect's Name ' 9 Address and Phone Mechanic's Name ti(� s ` Address and Phone �wM�s Construction Supervisors License#�S_ ��1_ 6�HIC Registration# �135k Estimated Cost of Project$ - IM012 Permit Fee Calculation Permit Fee$ Estimated Cost X$71$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 build to th tated specifications. Signed under penalty of perjury X G-- Date 6 I 0 4 IL on— -- CITY OF SALEM ' PUBLIC PROPRERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET * SALEM,MASSACHUSETTS 01970 TEL:978-745-9595 ♦ FAX:978-740-9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organizationl/Individual): / O Address: L �ivl AD -C /F City/State/Zip: Phone Are an employer?Check the appropriate box: Type of project(required): 1. tam a employer with 4. ❑ I am a general contractor and I 6. ❑Ne nstruction employees(full and/or part-time).* have hired the sub-contractors - 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /1 A e- /I v o 7 Policy#or Self-ins. Lic.#: iV G ^ A 7-Y & 3 `T (J _ _ Expiration Date: Job Site Address: s- 3 6,a v�c City/State/Zip: 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 criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 and ' sand nalties of er.ury that the information provided abov tru and correct. Si nature: Date: 7 Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/]License# Issuing Authority (circle one): 1. Board of Health 2.Building 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 employees=-- Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, 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 receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house 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 states 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 insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license 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 locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia CITY OF SALEM i!• PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON S•IxEEr•SALEM,MIASSACHCSLIl- S 01970 TEL,978-745-9595 • FAx:978-740-9946 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 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from ly licensed waste disposal facility as defined by MGL c this work shall be disposed of in a proper 111, S 150A. The debris will be transported by: r (name of hauler) The debris will be disposed of in : (name of facilitY) (address of facility) signature of permit applicant to drrbiisalr.duc Ili r DATE(MMID ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER -z� - / THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ASP S L, �7�`�tfPs ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ,S66Pq✓Yl S66TT 11'�/4 ' i9 EINSURERA ERSAFFORDI,N.11GCOVERAGE NAIC# INSURED : /V J re ST Te .L 1S:� PL, C: D:E: COVERAGES 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 DD' POLICY NUMBER POLICY EFFECTIVE POLICY E%PIRATION LIMITS HER TYPEgElb.15URAN�CC GENERALLIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Eaoocurence $ CLAIMS MADE OCCUR MED EXP(An,ona person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC EC AUTO MOBILE LIABILITY COMBINED SINGLE LIMIT $ (Eaaccident) ANYAUTO ALLOWNEDAUTOS BODILY INJURY $ (Per person) SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY $ _ (Peraccident) NON-OWNEDAUTOS PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EA ACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ TWC CRY UM U- OTH- WORKERS COMPENSATION AND II ER— EMPLOYERS'UP LITY ^L �• C// V / �� E.LEACHACCIDENT $ . RR ?ECUTVE /3- O /j OFFCE (MEM EXCLUDED I E.L.DISEASE-EA EMPLOYEE $3; Ifrs tlescdbe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER {'I CANCELLATION C ! �� I` �' /�� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN ,,y/ f�+ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL -9 () I / v ^'�\ -b p/Q 7- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Sa r Ll�� " / ry�� REHO El ATVES. (J ! AUTOO El EPRESENEATIVE PORATION1988 ACORD25(2001/08) A �� :.�/re �amosw�uoe¢Cl� o�✓dfamadea�elldr. BOARD OF BUILDING REGULATIONS Icense: CONSTRUCTION SUPERVISOR ' " Number CS 059622 Birthdate: 0?J1711964... $ f 6- Expires.62l17X'608. Tr.no: 17891:t Restricted 1G +{ . 4 39DRCHARDRD's SWAMMPSCCY1'xMA, t90 C OR. �/euo : <.•r�•-vx w "'�' Standards ' DOW at Bul�Idle4RaY°tap°�� m OMEIMPROVE ENT ORr, Re 113541 r - . ' T - ,. -'Fjcplratlon128/209 ` . s y a r 0 38 OitCHA D [�. .SWAMPSCO7T.:_t ,,,21897-;� ' n nK