4 BRYANT STREET - BUILDING JACKET § e aflm "
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Certificate No: 759-09 Building Permit No.: 759-09
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Pennits
This is to Certify that the RESIDENCE located at
--------------------------------------------------
Dwelling Type
4 BRYANT STREET in the CITY OF SALEM
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
OCCUPANCY PERMIT FOR A SINGLE FAMILY HOME jhb
This perm t is granted in conformity with the Statutes and ordinances relating thereto, and
expires __ _ -------, unless sooner suspended or revoked.
Expiration Date
-----------------�-- ------ - __ ______________-___--------
Issued On:Mon Jun 1,2009 - - - --------------------- -
GeoTMS®2009 Des Lauriers Municipal Solutions,Inc.
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CITY OF SALEM
BUILDING PERMIT
4 BRYANT STREET 759-09
GIS#: area COMMONWEALTH OF MASSACHUSETTS
Map: 27
Block: x' " CITY OF SALEM
Lot: ,. 0115 " ,
Category: REPAIR/REPLACE T T
Perm t# 759-09' BUILDING PERMIT
Project#"`' " JS-2009-001398;
Est.Cost: $2,500.00 s h
Fee Chaigcd' $25.00'm "fi ';r1lrFp
Balance Due: . r$.00.. :. PERMISSION IS HEREBY GRANTED TO:
Const.CtassCl" Contractor: License: Expires
Use Group: - . iii At Dennis Construction LLC
Lot Size(sq. ft.): 1595.1672
Owner: CHALIFOUR CLAIRE D
Zoning: R2
Units Gained: Applicant: CHALIFOUR CLAIRE D
Units Lost. AT: 4 BRYANT STREET
Dig Safe#:
ISSUED ON: 07-May-2009 AMENDED ON: EXPIRES ON. 07-Nov-2009
TO PERFORM THE FOLLOWING WORK:
PERMIT TO FINISH SINGLE FAMILY HOME REFER TO PERMIT 960-00
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: _ Rough: Foundation:
Final: Final: Final: Rough Frame..-
Fireplace/Chimney:
rame:Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil: 7� y �Q
Final: 1/J f(U
House N Smoke: '
Water: Alarm: 5—J2
]2 -)lo
Assessor Treasury:
Sewer: Sprinklers: Final:
THIS PERMIT
REGULATIONSOKED BY THE CITY OF SAL O b IVA
I.
Signature NOF F
RULES AND
Fee Type: Receipt No: Date Paid: '(,Check No: Amount:
BUILDING . REC-2009-001589 07-May-09 4004 $25.00
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CITY OF SALEM ,. .,.�•
11 .1,! SALEM, MASSACHUSETTS 01970 P ERMIT
9e�lmHe�e q/
' DATE ZG OQ €6 PERMIT NO. 96D DO
APPLICANT M`'J --1�iDBLYg/- - ADDR SS XZ �IC iY'/YT cS�T
(NO. ((STREET) (CONTR'S LICENSE) -
CITY . - STATE ZIP CODE TEL.NO.
NUMBEROF
PERMIT TO � SBP /I/LBI S-�^u STORY DWELLING UNITS
(TYPE IMPROVEMENT) N0. (PROPOSED USE)
ZONING
AT(LOCATION) — DISTRICT' ^`Z.
(NO.) (STREET)
BETWEEN AND
- (CROSS STREET) (CROSS STREET)
LOT
'SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE - FT.WIDE BY FT.LONG BV FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA'OR PERMIT$
VOLUME ESTIMATEDCOST$ G✓. BB(I FEE /;?L5-l
(CUBIC/SQUARE FEET)
OWNER
BUILDING �+
ADDRESS - `�. BV EPT.
Ly7
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS -
ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. -
MINIMUMOFTHREECALLINSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE _
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
1.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO 71T IS VISIBLE FROM STREET
BUILDING INSPECTION APPROV L PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 a /13'4
2 2 2 "I�50S C ?94- -
BOARD OF HEALTH GAS INSPECTION APPROVALS .FIRE DEPT.INSPECTING APPROVALS
1 A
OTHER CITY ENGINEER 2 2 rµ+..•
WORK SHALL NOT PROCEED UNTIL THE PERM 11=44I1_1_BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED.ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS NOT:,FARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. OR WRITTEN NOTIFICATION.
-'AS N.GTED ABOVE. — ------�_'^*.,�-- 1
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CITY OF SALEM
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The Commonwealth of Massachusetts
tsa wnof
Board of Building Regulations and Standards To
Massachusetts State Building Code, 780 CMR, 7ih edition Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Tao-Fu n iv Duelling
This Section For Official Use Only
(� Building Permit Number: Dale Applied: 7— ' .�
`V Signature: �t-+'� i3 7 10�
\` ^
Building Commissioner/Inspector of Buildings Date
^ J\ SECTION 1:SITE INFORMATION
�\ 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.la Is this an accepted street?yes_ no. Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq B) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required I
Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 13Public❑ Private❑ Check if Xes13
SECTION 2: PROPERTY OWNERSHIP'
z.��A/Q�Resor
Name(Print) Addiess fof Service:
Signatur Telephone
EC 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
Pv..,. -
Q
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building � 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) E List:
5. Mechanical (Fire S Total All Fees: S
Su ression
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S �3(� ❑ Paid in Full ❑Outstanding Balance Due:
3 c9 0
SECTION 5: CONSTRUCTION SERVICES
5.1 to
License Number ExIrat�Date
Ng of -- H Id AA e ti
Liu CSL Type(see txlow)
Ad es 1DResidenlial
Description
nrestncted u to 35,000 Cu. Ft.)
stricted I&2 Famd Dwellin
ur ason Only
sidential Roofin C.—w
Telephone sidential Window and Siding
sidential Solid Fuel Burning Appliance Installation
Demolition
5.2 Registered Home Improvement Contractor(HIC) /00.�?0 s�
HIC rr Nprrt�pr C Registra(t Name Regition umber
Add Sir q GHQ / W e
xpi a ion Date
Signa re Telephone
SECTION 6: WO RS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 25C(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........... 17
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
11 �" — as Owner of the subject property hereby
authorize Q.I.C. _ to act on my behalf,in all matters
relative to work authorized by this-lTuMcling permit application.
Si nature of Ow r Dates
SE W ,:'OnWNE�jR�t)O AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and info tion on the floregoirtg4pplication are true and accurate,to the best of my knowledge and
behalf. /� LA� N��S
Print Na J'V
S a
Signature df Gwner or Au rued gent Date
(Signed under the pains and tes of ru
NOTES:
I. 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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 1 I O.RS,respectively.
—Y.—When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,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 Cost'
CITY OF SALEM
1 A PUBLIC PROPRERTY
DEPARTMENT
Illi...
II I '1'3-'4; li4j ♦ 1 \C: 'i�% 'J:
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance %%ith the sixth edition of the State Building Coda, 780 Cb1R section 1 11.5
Dcbris, and the provisions of MGL c 40, S 54;
Building Permit 10 is issued with the condition that the debris resulting from
this work shall he di,poscd of in a properly licensed waste disposal lacility as defined by MGL c
I 11. S 150A.
The dch'is will he transported by:
(name of*hauler)
I he debris will be disposed of in :
Pw �r
(name of laclhty)
tsar
tacdav)
I�natwc o unut apple vnt
lite
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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NIP. aIN ,toll,'I I
11-. W,t,t11\t,j0N5I:ILL't • SAIPN/, M.t1w.0 III it 1 I,J197'�
Irete 'OI li'Ji'+5 • 1:%.x 9711-74,:'I346
Workers' Curnpensation Insurance %1ffdawit: Builders/Contractors/Electricians/Plumbers
%onycant Infnnnrtion Please Print Le ibly
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V i11nC lau.ule,vt)r;;]nV.ainIV lnJl,uluull: l//
:�11111'd5S: V `� /( C e e f/ - Qy /� /G
City,State./in- Phunei/: ! �/ / LQ � ,J I �J
�/�,r.c.,,sou an employer'!Check the appropriate box: l')pe of project (required):
I llJq,l :un a cmpluycr with 4. 0 1 :un a general contractor and 1 6. 0 new construction
1��engllo- (full und'ur part-tine).' have hired the sub-cuniracturs
2. 0 1 am a sole proprietor or partner- listed on the :machcd sheet. : 7 tetnodelinQ
ship and have no employees These sub-contractors have S. ❑ Demolition
Norking litr me in any capacity. %workers' comp. Insurance. g. Building addition
Igo workers'comp. insurance 5. 0 Weare a corporation and its
I required.) officers have cxcl'ciscd their 10.0 Electrical repairs or additions
3, 0 t ant a homeowner doing all work right of exemption per MCL I I.E] Plumbing repairs or additions
myself.(Ko workers' comp. c. 152, j 1(4),and we have no 12.0 Ruuf repairs
insurance required.) r ctnployccs. LKo workers' 13.0 Other
romp. insurance required.)
•lu. .,pphcmd Ibal checks box AI must alae till wi the w,11an Iwluw>lwwine Zhou wa(kwxi cumpen"iwr lwlicy mluroutiom
' I lomuuwncn,vhu motel(this amjavit indicating It c)an,doing all wurk a,x1 then hire uuhlde cutumcton muss.0 nnif a new'117M win indicating wI'll
-f'„elrwwn that(hack this box Mimi attaehanl.m additional,hcVt,hewing Lala(unto of Ik sub- ontrwlon and their wurken'comp.policy MfcawL
/am an cuyduyrr that it pruriding rvurAers'euorpanenriun inmrnnreJur ray rarpluyrex. Behnv is rhe pulley and job site
irrjunnuriva
Iii,urauce Company Naine: � n�L 7 --'-------
Policy a or Sclf-ins. Lice rr: `✓ _. . _ . __ EApiratlun Date: t/O
�A
Job Site Address:
Attach n Cully of Ilie workers' cumpenxatiun pulley declaration page(showing the policy number and ecpiratiun date).
hatluic to secure cuserage as required under Scaoun 25A ul'SIGL c. 152 can lead to the imposition of criminal penalties of a
line up to.SL500.00 and/ur onc-)car imprisonment, ax N"CII is cis II pCOalllcs in the loon of a STOP WORK ORDER and a fine
of up to 52in 00 it Jay .tguinst Ilse violator. He
ad •.u:d that a copy of the sldicinent tray be Iurwarded to the 011lce of
Irt,,au•}au,nn ul-thc DIA :or m,u, ince cowr.lg 1 itiaacon.
!du heri by,c rtifr wider t e p in'turd p itlt'- u)`perjurythat the in/brrnut/on provided ub/p�ve i /lrur raof correc'I.
r)�/iris/nu a+dye Do noir ening iu rhi.t urea, to beturup/rrrr/by a fry or rolvn a/jig iu/.
( itv ur fawn: ... _ - Permit/Lieeore it
Issuing Aullturilp (circle one):
I. I1t,arJ ..f lle.dlh t. Iluddiug Ocpartutcul 1. Gild.-fuan Clerk J. LNctriad lnwpcClor ;, plumbing Inspcclor
6. Other _
Cluuact l'l nue: .. _. Phone h:
Information and Instructions
\f.L S.IihUietls Gcnv'ral Laws chapter I i2 rcguircb all emplo)ers to provide workers' coinpensatlon for their cinployees.
[UWIU lull to(n is ,I atute, in empluree Is defined s " es ery Pelson in the service of another Lill,ler.uly contract of hire,
e.press or implied. oral or wnnten.-
.\n empluy,•r Is defined as "an Individual, partnership, .ssocianou, corporation or other legal entity,or any two or more
'r the h,rcgulr,g engaged it a joint cncrprisc. and including the Icgal representatives of a deceased cmpluycr, Lir the
rcccncr or trusnee of.m Individual,parutcnhnp, assoctanun or other legal conty,employing employees. However the
owner ofa dwelling house having not more than three apartments and who resides therein, or the occupant of the
,lwcllolg house of another who employs persons to do maintenunce,cumtruction or repair work on such dwelling house
,{r Mi the grounds or budding appurtenant,thereto shall not because of such employment be deemed to be in emplo)er."
MGL chapter 152. �s25C(6)also stares that"every state or local licensing agency Shan withhold the issuance or
ren'ewpl of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant olio has not produced acceptable evidence of compliance,with the insurance coverage required."
\.Idiuonally, NIGL chapter 152, a25C(7)stades"Neither the conunonwcahh nur'any of its political subdivisions shall
enter into any contract for the perfornwMC uf-public wurk until acceptable evidence ol'compI lance with the insurance.
requirements of this chapter have been presented to the contracting authority."
Applicants
Please rill 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 nualiber(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
.\ccidems for confimtatiun of insurance coverage. Also be sure to sign and dale the al'fidavil. The affidavit should
lie retuned 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
c)f-insurance license number on the appropriate line.
City or'rown Officials
please he sure that the affidavit is complete and printed legibly. The,Department has provided,a space at the bottom
of lite affidavit fur you to fill out in the event the Office of fnvestigations has•to contact you regarding the applicant.
111:ase be sure to fill in the pennit/license number which will be used as!.reference number. In addition,an applicant
that must submit multiple pennitaicense applications in any given year,need only submit one affidavit indicating current
policy information.(if necessary) and under"Job Site Address"the applicantshould write ,all locations in (city Lir
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 cltizcit is obtaining a license or perinit not related to any business or commercial venture
(i.e. a dug license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
I h: I)Mice Or lovesrigatiun> \Wuld line to drank )ou in advance fur your cooperatiotn and should you ha�c any queslioni,
please do not hesitate to give us a call.
fhc Dcparuncol's address, telephone and fax number'
The Commonwealth of Massachusens
Department of Industrial Accidents
Offlce of Investigations \ ..
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax N 617-727-7749
a:%:.cd 5 _'u u5
www.mass.gov/dna