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61 BROAD STREET - BUILDING JACKET Opo ESSELTE 10°x, o a o 0 urnMr-n---"h of Massachusetts - Vily .of Salem. 120 Washington S4 3rd Floor Salem,MA 01970(978)745.9595 x5641 " Return,card to Building Division for Certificate of Occupancy - ° EEPAtNo.:� 616-?311 VERMIT TOBUILU d " FEE PAID. $56:00 ,: „ DATE ISSUED: r .1111412018 ,° ' �: `' ■ Thls certifies that 61 rBROAD STREET REALTY TRUST CRONIN CHRISTOPHER . • ° -. w ' has peimisslon•tc erect attef,bor;demolish a building 61 BROAD STRUT °s ° Map/.L©f.'250275-4° as follows ;Sheet Metal° ' RUNNING NEW DUCT WORK FOR SUOPLY& RETURNS,FOR NEW HEATING & AIC SYSTEM FORy _2ND & 3RD FL.; AND NEW UNIT IN THE BASEMENT°FOR THE FIRST FLOOR s APT.y . .-Contractor Namei ,BILLY SILVA , ; ti o ° "' °� •� .N ? DBA:. a � s . ContractdfiLlobnse No:°4446 a E .. . 11/14/204�6 " 2 � rte• t ` 4 dR.. - � " Building Official W -Date i " This permit shsll'be•deeined abandoned and`invalid,onless.the work-"orized bythis permit Is commerfced�wit6in six rAnths after issuance;The Buildng,ofgclal - i ma)rgrant one.or more extensions not to exceed six<monlhs eech upon written request: 'All work authorized'by this permit shall contorm Co the approved appiisation and the approved construction docurnso for which this perrhILhas been,granted. R k ` - All construction„akerepons and'cnanges of use of°any building and sWotures shalLbe in compliance with the lorakzorif ng bMAs and codes.' • ` _, - g a g. This permit shall be displayed in a locaoonclearly visibb from access street or road and,shall be maintained openlor public inspectldmfor the�ehtireratio °duhof the - _ a work unfit the completion of the-same i ” The Certificate of Occupancy wilLhot be,iasu'ed'unti4alk§pplicabls sigfiatures by the Building And.Fire.Pffbials are provided om tom-permit. - " ° o jo19 HIC#: �. Pv¢ ,°, Wrsons contacting M�unregistered contractors do-V have access to the guaranty;Ai (arse forth In ml c.142A):_ Restrictions: ; ° Building plans are to be°available on site. a All Permit Cards are the'piropetty of the PROPERTY OWNER.. yPc.rr Commonwealth of Massachusetts Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745.9595 x5641 41 Return card to Building Division for Certificate of Occupancy structure CITY OF SALEM BUILDING PERMIT PERMIT TO BE POSTED IN THE WINDOW .r Excavation �. Footing' INSPECTION RECORD. Foundation ° Framin Q l�3 Mechanical Uie LV a w; Insulation INSPECTION: BY DATE Chimney/Smoke Chamber - `Final 1,G r Plumbing/Gas # Rough:Plumbing ' Rough:Gas Final a Electrical La Service Rough Final °Fire Department Department Preliminary L, c . Z� Final �) Health Department [+s ,Preliminary r' .Final ° 7 72 as �j ph c+ 'k�x ��� „{^ $ #�.'",�.�`{ e � � �`#'.� .n 'eV•IT111��� �}�� ta�`I���^a�t3�`f�1�S�x'�� Of N } 4 d .fsKI `ice' $ � 11TR6� r� RM, r`3 �N s* t 4n es, �� � � xa. yyy� c ��M+/. �R'yA xaheepQ^^�nn $rSPvn� E �j �x >'•'^ ." 'S: oft , yiy ^Z.� i p�11F18StD a>kaslx n x i i . w A } iA t x lgYY r ° Thws certifies heat ` �J i r 3�8fi c{ r A Lty4*u 6t CR.flt t E{RIS 1IE ..; g too )Y. v .. x ,Y` S,-... �s h a'•e ,q<, x y.. t } y >iaF$,x. y, tx ",' Y ri 1E.�'",+"1 x ""yc 1"..$ye, i. 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'i°-✓..fY.:,� 4 .: Y` '^ x':i "rq s g„ of Massachusetts y` �3 ' uav of Salem rt q �o 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 ° xµ Return card to Building Division for Certificate of Occupancy Permit No.. B-16-1311T® BUILD U I L FEE PAID: $56.00 OPERMIT DATE ISSUED: 11114/2016 This certifies that . 61 BROAD STREET REALTY TRUST CRONIN CHRISTOPHER has permission to erect, alter, or demolish a building 61 BROAD STREET Map/Lot: 250275-0 as follows:, SheeYMetal RUNNING NEW DUCT WORK FOR SUPPLY & RETURNS FOR NEW HEATING & A/C SYSTEM FOR 2ND & 3RD FL.; AND NEW UNIT IN THE BASEMENT FOR THE FIRST FLOOR APT. Contractor Name: BILLY SILVA DBA: Contractor License No: 1446 11(14/2016 Building Official Date This permit shall be deemed abandoned and invah6unless the work authorized by this,permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. Y - All viork authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Ali construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. - - The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. H IC#: Persons contracting with unregistered contractors do not have access to the guaranty fund'(as set forth in w,3L C.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts ' City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW Footing INSPECTION RECORD Foundation Framin �� /yr Mechanical LIj,,. �L Insulation INSPECTION: BY DATE Chimney/Smoke Chamber Final f1 t V Plumbing/Gas Rough:Plumbing Rough:Gas - Final ''s Electrical Li Service Rough Final 0011111 Fire Department Preliminary Finale • 'Z,� ZtE Am Health Department Preliminary Final t: w f .s, 4 a iitfWSslc asetts irb7n"(978)i45-959e X5641, 2 y- aa ong Division for Certificate of Occupancy Permit No, , B-16-1015 PERMIT TO BUILD FEE PAIDr $575.00 � n ° DATE ISSUED: 1 9113/201 t .h This certifies that 61 BROAD STREET REALTY TRUST CRONIN CHRISTOPHER has permission to erect, alter, or demolish a building 61,BROAD STREET_ Map/Lot: 250275-0 s as follows: Other Building Permit REMODEL KITCHENS & BATHS. ADD TWO (W) BATHRROMS; MOVE PETITION WALLS(NON-LOAD BEARING); INTERIOR ALTERATIONS Contractor Name: JOHN CAMIRE: - - 4 DBA: JJC GENERAL CONTRACTING Contractor License No: 095885 P.j• any G. L { b LT A D� -�"' ,,� .E 9/13/2016 Bul ding Official Date .° This permit shall be deemed abandoned and kivalid=untes.A the work authorized by this permit is commenced within six months after issuance.The Building Official . ' may grant one or monAxtensions'not io exceedstx mfr 6s each upon written:request. ti ' All work authorized by this permit she I conform to4he-approved applkation•and the°approved construction documents for which this permit has been granted. All construction afierstionsand changes of use of anybuilding.and.structures shall be in compliance with the local zoning by-taws and codes. o c, , ' - tThis permit shall bedisplayed ina,location clearly visible from access street or road and shall be maintained open for public Inspection for the entire duration of the work.until'the completion of thetsamea " - The Cd rtificate;of-Qccupancy will,not be issued_until all applicable signatures by the Building and Fire Officials are provided on this permit. .HIC#: ,182125: a , �,. •Per$ons contracting with unregistered contractors do not have aecess to the guaranty fund"(asset forth In MGL 042A). e - 'Restrictions!' Building plans are to be available on site. P re the property of e P . All errnit Cards a the PROPERTY OWNER X4.0 qjy vY ax - Comtri�nvw ac set" a.. 1VO C fi r p "1 y 120 W-as in9fon'st,3rd F10 safim,+- s7o(s7H}745-s595 r.5'�+{7"'°^'^"�•^! `^°^' -'•�j°'4: +Y'��' �.-} � ..-.. r Return°card to Building Divipnis for Certificate of Oceuparcy ` tt structure' CITY OF SALEM BUILDING PERMIT Eon - - - x PERMIT TO BE POSTED IN THE WINDOW. : Foodng INSPECTION RECORD . . on - ... FremtnIw•�n� d Mechaa cal .... _ t InuMdriINSPECTION': _ BY -DATE r � { Chimna�/Smoke Chamber Final 10/f m Plumbing/Gas T J (a Electrical ,� service# /� ° ° Rough 't ; pro Fite Department - tip.. o Haalfb+Departmept .y .�� *�� �.''.7tr`—. o"."....C'z"� � ,.. �.. -•.e'y'^'-xs-.•» vc^'.�.,,�_"',"s.�'�w. .,,.,,,.;,<�,. � s 1 f '1cna ryrya r +kp�2�'4 r`,�°'` sem'.-a ��"�'} ��iY i '. 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Itv o Sajem r— --"- - — Aa �- -' -- --- —'120 VTngtoh81,3rd Floor ern.MA x5541—' --- -- - +- ,�— Return card to Building Division for Certificate of Occupancy ®� ^� structure CITY OF SALEM BUILDING PERMIT Ex on PERMIT TO BE POSTED IN THE WINDOW a � Footing° INSPECTION RECORD a Frarnn il/.�.- / � t( II Machanical I a I(F Insulation INSPECTION; BY DATE v. Chimney/Smoke Chamber � I Final 09 S .t �� ^ 6e- Cem7Vee3 f7;2 Plumbing/Gas Rough:Gas /� "t9'/�7� .))g/ ° t ave^^ Final Electrical Service ° Rough o i I " ire Department j P 1 Health.Department ° 3ry .r a r , . . "tea"9aP. a@r a °=9i.� -_• . . � � � 1��� +• ° �.. o.IVa �OONOID,Iy t t;�°�.i,to;ern^.,aa1tF;,{fiv;asssr: Asetts 'glil4 L..'rl5oor Y :'::.vi970(978)745-9595x5647 Division for Certificate of Occupancy Permit No. B-16-1015 PERMITFEE PAID: $575.00 TO BUILD " DATE ISSUED: 9/13/2016 This certifies that 61 BROAD STREET REALTY TRUST CRONIN CHRISTOPHER has permission to erect, alter, or demolish a building 61 BROAD STREET Map/Lot: 250275-0 as follows: Other Building Permit REMODEL KITCHENS & BATHS. ADD TWO (W) BATHRROMS; MOVE PETITION WALLS (NON-LOAD BEARING); INTERIOR ALTERATIONS Contractor Name: JOHN CAMIRE DBA: JJC GENERAL CONTRACTING Contractor License No: 095895 /f 9/13/2016 Building Official Date This permit shall be deemed abandoned and invalid.unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. ° All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. ° All construcGon,'alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the.same: jr The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. HIC#" .182125 "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL 042A). p Restrictions: At Building plans are to be available on site. 'd All Permit Cards are the property of the PROPERTY OWNER. CITY OF SALEM, MASSACHUSETTS 4# ' BOARD OF APPEAL � JJ 'fj� �f�y 'fin p !: QD 120 WASHrNGTON STREET 4 SALEM,MA3S��Ti1}5�'IMI R YjMsERLEYDRlscou. TELL:978-745-9595 1 FAX:978-740-984FILE � MAYOR CITY CLERK: SALEM, MASS November 30. 2016 Decision City of Salem Board of Appeals Petition of CHRISTOPHER B. CRONIN, TRUSEE, seeking a Special Permit per Sec. 3.3.3 Nonconforming Structures to expand an existing rear deck and provide access to an existing second floor unit by means of an exterior stairway at 61 BROAD STREET (Map 25, Lot 275) (R-2 Zoning District). A public hearing on the above Petition was opened on November 16, 2016 pursuant to M.G.L Ch. 40A, § 11 and closed on that date with the following Salem Board of Appeals members present: Rebecca Curran (Chair),Peter A. Copelas,Tom Watkins,Jim Hacker (alternate),and Paul Viccica (alternate). The Petitioner is seeking a Special Permit per Sec. 3.3.3 Nonconfeming Stradures to expand an existing rear deck and provide access to an existing second floor unit by means of an exterior stairway at the property. Statements of fact: 1. In the petition date-stamped October 25, 2016, the Petitioner requested a a Special Permit per Sec. 3.3.3 Nonconforming Structures to expand an existing rear deck and provide access to an existing second floor unit by means of an exterior stairway at the property. 2. Attorney Scott Grover presents the petition on behalf of the applicant. 3. The property is an existing two-family home in an R-2 Zoning District. 4. There is an existing nonconforming rear porch that is within the required 30' foot rear yard setback. 5, The petitioner is proposing to expand the second floor deck along the entire rear facade and construct an exterior stair to serve the second floor unit. 6. Currendy, the property is a two-family home with access to both units through an interior common hallway to create more interior space for the two (2) units. 7. The petitioner is also proposing to install a driveway where there is currently a landscaped side yard to provide off-street parking spaces, 8, The requested relief, if granted, would allow the petitioner to expand an existing rear deck and provide access to an existing second floor unit by means of an exterior stairway. 9. At the public hearing, two (2) members of the public spoke opposition to and no (0) members spoke in support of the petition. City of Salem Board of Appeals November 30,2016 Project: 61 Broad Street Page 2 of 3 The Salem Board of Appeals, after careful consideration of the evidence presented at the public hearing, and after thorough review of the petition, including the application narrative and plans, and the Petitioner's presentation and public testimony, makes the following findings that the proposed project meets the provisions of the City of Salem Zoning Ordinance: Findings for Special Permit: The Board finds that expansion of the rear deck and associated stairway will not be substantially more detrimental than the existing nonconforming structure to the neighborhood. 1. The proposed extension of a non-conforming would not be more substantially detrimental than the existing non-conforming structure to the impact on the social, economic or community needs served by the proposal. 2. There are no impacts on traffic flow and safety,including parking. 3. The capacity of the utilities is not affected by the project. 4. There are no impacts on the natural environment,including drainage. 5. There are no significant impacts to the neighborhood character. 6. The potential fiscal impact,including impact on the City tax base is positive. On the basis of the above statements of facts and findings, the SAiem Board of Appeals voted four (4) in favor (Rebecca Curran, Peter A. Copelas, Tom Watkins, and Jim Hacker (alternate)) and none (0) opposed, Paul Viccica (alternate) abstained, to expand an existing rear deck and provide access to an existing second floor unit by means of an exterior stairway subject to the following terms, conditions and safeguards: Standard Conditions: 1. The Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner. 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. Exterior finishes of the new construction shall be in harmony with the existing structure. 6. A Certificate of Occupancy is to be obtained. 7. A Certificate of Inspection is to be obtained. 8. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to,the Planning Board. City of Salem Board of Appeals November 30,2016 Project:61 Broad Street Page 3 of 3 Rebecca Curran,Chair Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision,if any,shall be made parrruant to Section 17 of the Masmchuntts General Lama Chapter 40A,and shall be filed within 20 days of fxh'ng of this decisien in the office of the City Clerk. Pursuant to the Massachusetts General Lams Chapter 40A,Section 11, the Varance or Special Permitgranted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed Hath the Essex South •b"sity of Deed, Plans must be filed and approved by the Inspector before a permit will be granted. t No. �M City of Salem Ward_ IS PROPERTY LOCATED IN THE HISTORIC DISTRICT? Yes_No— IF SIDING, HAS ELECTRICAL PERMIT BEEN OBTAINED? Yes No Home Phone # APPLICATION Bus. Phone # FOR PERMIT TO ROOF, REROOF O INSTALLSIDING Salem,Mass., Lrl/.> q 3 TO THE INSPECTOR OF BUILDINGS: The undersigned herebv applies for a er it to buil ccording to the follow/sp cifR ications:� Owner's name and address � _ �tLu.a�,l FFG Architect's name — - Mechanic's name and address Location of building.No. What is the purpose of building? _ Material of building? Asbestos? If a dwelling,for how many families?_ Will the building conform to the requirements of the law? Estimaied cost b 600, Contractors 'c.No. .3 Signature of applicant REMARKS SIGNED UNDER THE ,a ` � PENALTY OF PERJURY. C�)6 ' No. / / Wardy APPLICATION FOR PERMIT TO ROOF REROOF OR INSTALL SIDING Location �j R ( oc �, PERMIT GRANTED �q 197✓ Approved p cp..l B 1 di Ins or 6�LL � � � n eO,4 -D � t� ���ZC746f�!/itlldef�.6 ViehDukakis G ,.are&� .�&& clew ovarrror On. � � _ '30' Kentaro Tsutsumt v asaa a 02!08 Chairman 16171 -3 Chutes J. Dineao Administrator MEMORANDUM TO: All Buildine DepartmentsrStatc Building Inspectors FROM: Charles J. Dineno. Administrator DATE. October 31. 1788 SUBJECT: MGI. c.fo, %54. Added Rv e594. S9 of the Aetx of 19117 The above-mentioned statute requires that debris resulting from file demolition, renovation. rehabilitation or other alteration of a building or structure he disposed of in a properfv lu:cnscu solid waste disposal facility as defined by MGL &;Ill. 5150A and that nuddine permits car licenses arc to indicate-the location of the fatality at which the said debris is it) he disposed. THIS REOUIREMENT DOES NOT APPLY TO NEW CONSTRUMON. In order in stmolifv the process and ui provide uniformity. we arc attaching a copy of a form which ,you can either reproduce and use u at is since the completed form will be attached to the office copy of building permits or licenses: or reproduce it on your Ictterhcad. In else of municipal,commercial.industrial,or multi-tout housing construction. the contractor may not know the dumpster subcontractor at the time of the budding permit application. In such cases, the attached COPY of an Affidavit can be used. The complete law is contained in the November Issue of CODEWORD which will he matictl to von in the nest two weeks. If you should have any question, please let us know. CJD1km AFFIDAVIT As a result of the provisions of MGL c 40, S54, 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 (Ttvo months maamum) 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. T Date Signore of Permit Applicant (Print or type the following information) Name of Permit Applicant Firm Name, if any Address 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 15QA. The debris will be disposed of in: (Location of Facility) Signatur6 of Permit Applicant s-43 Date 744 P COMMONWEALTH OF MASSACHUSETTS ~ I�r DEI'ARI WENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET fames ' Campoeil BOSTON, MASSACHUSETTS 02111 mom^ssrone 'WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, (iicenseefperminee) with a principal place of business/residence at: n/ (City/Stare/Zip) 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. 3 /a - V y Insurance Company Policy Number 1Q/I am a sole proprietor and have no one working for me. ( j I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the f—ollowing workers' compensation insurance policies: Name o CironrmcEor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number (� 1 am a homeowner performing all the work myself. NOTE: Please 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 which the homeowner also resides or on the grounds appurtenant thereto arc 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 my evidence the legal sums of an 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 SI 500.00 and/or imprisonment of up m one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. Signed this S✓ day of 19 19,93 Licensee/Perm ct Licensor/Permittor Commonwealth of Massachusetts Or, I Sheet Metal Permit � 1 t33ltCs" °a? �f,tl�l4lAt '. Date: . J -/ 20( l/ Permit# Nip . Estimated Job Cost: $ 5j-()go �, 191b 0 Permit Fee: $ , Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# l t f f (p Cd Business Information: Property Owner/Job Location Information: Name: Ulti SJU-1 Name: e- &L+eS Street: Z D h c1 t S 4- Street: 1 13ro,, Z S t City/Town: City/Town: St e rti Telephone: - q (a 0- S`7 -3S r� Telephone: I 0 Photo I.D. required/Copy of Photo I.D. attached: YES_ NO_ Staff Initial J-1 /M-1-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family-Z' Multi-family Condo/Townhouses Other Commercial: Office— Retail— Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft.— over 10,000 sq. ft.— Number of Stories: Sheet metal work to be completed: New Work:_ Renovation: _ fIVAC_Z Metal Watershed Roofmg— Kitchen Exhaust System— Metal Chimney/Vents— Air Balancing— Provide detailed description of work to be done: RIAnv1I- C N2 &✓ akr 1'7 titi Ce� hrh S 10 � A C B�S � e .. �y � 21�c� �tia 912 T-loo� e� j%�c0r To G Co�A4 C I INSURANCE COVERAGE: I have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes 0 No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy 3he Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only y Owner ❑ Agent Signature of Owner or Owner's Agent By checking this box❑,1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES_NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Tine ❑ Master-Restricted Cityrrown Joumeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: !yy (D Fee$ ❑ Check at www.mass.00vldpi Inspector Signature of Permit Approval v DR as�ozo�2 xm>E S81347876 r Od20�17; u Q�4-Ii81980 r s#EVA ^= z8ILLY0 - a20UaLEYSfgEETS . .. MA 019im ♦ 0 s®ummiaw.w-isms rFvEmputq . ,.COIViMOPiWEpLTH OF MASSACHUSETTS .F .SHEET METALjaoARnoTWORISERS - ISSUES THE FOLLOWINGLICENSEAS A , JOt1RNEYPER30N UNRESTRICTED ¢"f} BILLY 0 SILVA A' ;Z DUDLEY ST PEABODY,,MA 07980-4016 ij 1446 04/28/2098. c 3228z F9 D• t�s�t fieaE� of �om�€ioez silty 0.:Slva „ ����/� Val Fw*' - �. - Technician:TYPE UNIVERSAL c aL 4e,7"k d 6y 96 60 82 &,brad 1 2247670 3f972006 ' '-.�''_ -, I0 Norma: 'Bcm ..:mm�mt aat r�rnz R- 11/10/2016 11:48 9785315142 PAGE 01/01 �� DATEIMMIODIYY/Y) A6C CERTIFICATE OF LIABILITY, INSURANCE 11/10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: R the comfk:Bte holder is an ADDITIONAL INSURED,the Pollcy(las)must have ADDITIONAL INSURED proVlsloos or be endorsed. R SUBROGATION IS WAIVED, subject to the terms and condit ors of the Policy, certain pollcies may require an endorsement. A statemant on this cortmcate dose not center rights to the certificate holder In lieu of such endersornent(s). PRODUCSR NAME: GOSIA JOHN V ZANNINO INSURANCE AGENCY PHONE . (978)531-5757 aCNq:I976)531^5142 16 Foster St AODRESS:GOSIA@ZANNINOINSURANCE.COM Peabody, MA 01960 maofffNA) APPOROe1e COVERAGE xacv INSURERA;NORFOLIK & DEDHAM MOTUAL iNSUREO HILLY SILVAA INSURERB 2 DUDLEY STREET INsuRERc: PEABODY r MA 01960 INSURER D MSURga E: , mBURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LT R TYPE OF INSURANCE ` LIMITS LTR .N POLICY NUMBER MMID CGNMEAdIAL GENERAL MABILMY EACH OCCURRENCE Is 1,000 ,000 CLAIMS MADE ®OCCUR PREMISES fEa OLQIrrBMCI $ 5O[0O0 R1530712A 09/09/26 0-4/08/17 MEDEXP anePeme ) $ 5 .000 A PF-RSONAL6ADVINJURY s GFNL AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE $ 2,000,0 POLICY 2 LOC PRODUCTS-COMPIOPAGG $ 2r000r000 E OTHER: AUTOMOBILE LIABILITY ER acddan! $ ANYAUTO BOOILY INJURY(Per parser) 5 OWNED LY SCHEDULED BODILY INJURY(Per eaNaeat)Is AUT03 ONMIRED NON-OWNED Is AUTOSONIY AUTOS ONLY (Per ecmaem) _ $ UMIA"'A LIAB pCCUR 5 OCCURRENCE. $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED RETENTIONS S WORKERS COMPENSATION $igTUTF. ER AND EMPLOYERS UABIUTY ANY PRDPRIETORRARrNERF-I.L IVE Y❑ NIA E.L.EACH ADGmENT $ OFFICEWMEMBER EXOLUDE07 E.L.DISEASE-PA EMPLOYE 5 IMlmdeey Ie NH) „ IF yn tlasc lba under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POCCY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEMUES (ACORD 101,Addlllonal Remake Schedglq,may be esecred If mom%pace is required) CERTIFICATE HOLDER CANCELLATION CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN INSPECTIONAL SERVICES ACCORDANCE WITH THE POLICY PROVISIONS. 120 WASHINGTON ST SALEMr MA 01970 nurND SENTATIVE FAX: 978-740-9846 ®1988.2015 ACORD CORPORATION. All rights reserved. ACORD25(2016103) The ACORO name and logo are registered marks of ACORO The Commonwealth of Massachusetts Board of Building Regulations and Standards SALEM Massachusetts State Building Code,780 CMR L Building Permit Application To Construct,Repair,Renovate Or Demolish a RIV Q b One-or No-Family Dwelling But7ding Peamh Num;, Applied:, �90416 Siltation, 1 1SECTlbN 1: Il!t8s[a1t3N14TXO r3TQ _. _ 1. rgpe �dd�res : 1.2 Assessors Map&Parcel Numbers Us Is this an accepted street?yes—>,1C na. Map Number Parcel Number 111 13 Zoning Information: 1.4 Property Dimensions: Z,tmiag DzWct Proposed Use Lot Area(sq it) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yet& Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: — Outside Flood Zone? Muaicipa site disposal system ❑ Check if yes❑ SECTION 2""PROPERTY , 21 Owner'o R cor 1 Pam,e t "'\, City,State, -- )?'}��6583 �.�5. aSSOGi�,?eg t�C iS� ija tau o. Street Telephone Email Address SECTI S:DESCRIPTION OF PROPOSED WORKr(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ Repai rs(s) Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: nefDescription ofProposed Worle: #^ 4,,J �:: M SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: item abor and Materials Offieral use Only I.Building $ '} t> L L"tullding forinif Fee$ l)"—how fee is determine& 2.Electrical $ O Standard Cityffown Application Fee O Tow Poi ct Pose(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ Lam: 5.Mechanical (Fire $ Suppression) Total All Fees:$ j Cheat No. Check Amount: Cash Amount. 6.Total Project Cost: $ k>lj � O Paid in bull ❑outstanding Balanus Due: SECTION 5 CONSTRI)MON SERVICES 5.1 Construction Supervisor License(CSL) cS-oSSs�S Zd 5-0 h K CQ&N,ie. License Number Expiration Date Name of CSL Holder Lin CSL Type(see below) 1 (;a- t_G6,rcftq S4. No.and Street t ed �q Vw\ M4 OlC( 7C) _ _ R Restricted M2 F mi dly ings Dwelling000 cu.ft City/Town,State,ZIP M masonry RC Roofing Covering wS wVowandSi 1 SF !'bd Fuel Burning Appliances q7f-.S$oa�7� JJCC'af�Pml�C.an�lKiCd�tigWygka I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ' Sal r�S SOI �a k h CSS i f'e HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name C; Iq mento No.and StreetEmail address S� ww�- r-\9, olR70 G?&-S8c>r1174 Ci /Town State ZIP Tel hone _ SECTION&WORKMS4 COMPENSATION Ug9UMNCE AFFMA1 VIT(WLGJ-c:152.4 25)(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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........O 7a:OWNER AUTHORIZAMN TO Elk COWLETED WHEN OWNER'S AGENT Q WrQR.APFJJ9S,k IIRtP lPXMMr I,as Owner of the subject property,hereby authorize 1 l ! )P/atrr 1 to act on my behalf,in all matters relative to work authorized by this building permit application. t Print Owner's Name(Electronic S' ature) Date SECTION 7b:OWNER'OR AUTIIORU"AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained ' this application is true and accurate to the best.of my knowledge and understanding. 1�1-5;1-/6 Pn�wner's or Authorized Agent's Name(Electronic Signature) Date NOTES 1. 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 fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at aa�anv.mass.lovloca Information on the Construction Supervisor License can be found at 3DDL.mass.gov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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 Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Con" ' iLK fY 18�{�.�7,15-9m4 -9mi Ji,I1`CPl�l7Mbl SA�EWEYDWS4XL MAYGIR TW"STJUM Construction Debris D1spow1 Af,f�`dvvit (required for all demolition and.renovation workj In accordance with the shah edition of the State Building Code, 780 CUR, Section 111.5 Debris, and the provisions of MGL c40,S 54; Building Permit g is issued with the condition that the debris resultft from this worts shall be disposed of in a property licensed waste deposit facility as defined by AM c 111,S 150A. The debris will be transported by. (name of hauler) The debris will be disposed of in: (name of facility) (address of facillty) 91jirature of applicant - F- 16 Date k.' The Commonwealth of Massachusetts Department oflndustrialAecidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www massgovldfa Wilvorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �+ Please Print Legibly Name (Business/Organization/Individual): J T mac•J c, G e erq\ C Q�('C o f Address: G a- ICt"41g%(t s+ City/State/Zip: OWI-N meq, GM 70 Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.El I am a employer with employees(full and/or part-time).• 'l. ❑New construction 2.0am a sole proprietor or partnership and have no employees working forme in 8. LE eemodeiing any capacity.[No workers'comp.insurance required.] 9. 3.0 I am a homeowner doing all work myself 1No workers'comp.insurance required.]t ❑Demolition a 10 Q Building addition 4.0 I am a homeowner and will be hiring contraemrs to conduct all work on my property. 7 will ensure that all contractors either have workers'compensation insurance or are sole 1 I.[:J Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the subcormactors listed on the attached sheet. 13 ❑Roof repairs These subcontractors have employees and haw workers'comp.insurances 6.Q we are a corporation and its officers have exercised their right of exemption pet MGL c. 14.Q Other 152,§l(4),and we have no employees.[No workers'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 him outside contractors must submit a new affidavit indicating such. tContractors that check this box most attached an additional sheet showing the name of the sub-cnmructors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they most provide their workers'comp.policy number. I am an employer.that is providing workers'compensation insurance for my employees. Nelow is the policy and job site information. {] / t f p _ Insurance Company Name: �?eSe iN.y g7g- 74*S–'6y6r t ('CC�`�Ja , Policy#or Self-ins.Liic.#: Expiration Date: C, t Job Site Address: Rroad E4� City/State/Zip: IPP% Iv\q, GA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains and alties ofperjury that the information provided above is true and carrect. I p y Signature f'~j^ C �Gfs+Z— Date �•g�00 , Ci Phone#: -rte'"c 1?9 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 1521§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-contractor(s)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 cant'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 permi/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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia " ®} Massachusetts,Department of Public Safety s p Board of Building"Regulations and Standards License: CS-095895 Construction Supervisor JOHN J CAMIRE 62 LAWRENCE STRE I SALEM MA 01970 "M /'i �"N` CA— Expiration: Commissioner 0712212018 �z�rYrnmemw�ea�n�P/��?:raae�ueaelXh "Ocoee of f onsumer Affairs&)tas:Hess Regulation III x OME IMPROVEMENT CONTRACTOR eglstradon P25 Type: +� Expiration 6f 32017 -Individual # JOHN CAMIRE , JOHN CAMIRE yf 82 LAWRENCE ST SALEM, MA 01970 - ' _--- Undersecretary I