23 CONANT ST - BUILDING PERMIT APP The Commonwealth of Massachusetts
rBoard of Building Regulations and Standards CITY
Massachuselts State Building Code. 780 CMR. 7'"edition 0F SALFM
Rrvised Jurnay.y
Duilding Permit Application To Construct, Repair. Renovate Or Demolish a 1. 2WIV
One-or Two-Family Dwelling
This Scclio O1Tjcial Use Opt
Building Permit Number: Dale Appli : /
Signature: Zej) I /IL
Building Commissioned lm ild'u B fate
SECTIO 1:SITE INFORMATION
1 Pro rry Address: 1.2 Asaesson Map 8 Parcel Numbers
r nr�ra.��. slreet
Via Is this an accepted sired?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Ama(sq 11) Frontage(11)
1.3 Building Setbacks(R)
Front Ywd Side Yards Rear Yard
Requited Provided Required Provided Required Provided
1.6 Water Supply:(M.G.1,c.40.§Sa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:er
Public lsJ Private❑ Zone: _ Outside Flood Zone? Municipal"site disposal system ❑
Check if es❑
SECTION2: PROPERTY OWNERSHIP'
r
OrrA-er Plrllrvrd�l6 1'ritic tsuZm o�3 A. 4A4 S*
N (Print) Address for Service:
�I I� t11} W- 6 (,9 1
Signaure Telephona
SECTION J: DESCRIPTION OF PROPOSED WORKS(check a8 that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) W Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ NumberofUnits_ Other ❑ Specify:
Brief Description of Proposed Work':
T r.
OZ
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Offlclal Use Only
Labor and Materials
I. Building S 3ct.qm °t' I• Building Permit Fee:f Indicate how tee is determined:
?. Electrical f 6 6 O ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
J. Plumbing S ao 2. Other Fees: S �� \
J. Mechanical (IIVAC) S List:
S. Mechanical (Fire S
Suppression) Tolal All Fees:f
Check No. Check Amount: Cash Amount:
6. Total Project Cost: Ste'".Zi, 000 O Paid in Full O Outstanding Balance Due:
��A-� aq 044�,,a,� %,o
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Contraction Supervisor(CSL) �9 & 7 2- (Cr O lk
JBI ^ n}c L l I.icerae Number F.4pinlion I}ate
Name ul C'SI.•Ihdder i y� R list C'SL Type ism below)
" A Tt i-.ti /?l.�' 'v Q�Y'r�y f Description
U l Inreslricted u to 73.000 C u.Ft.
R Restricted Id2 Fami 0wellin
Si azure M M last
97 ZG-4 - 09 Z9 RC Residential Routine Covering
1'dephone I WS I Residential Window and Siding
SF I Residential Solid Fuel Buterins Appliance Installation
D I Residential Demolition
S.1_"Iste H onrW f III C p�eroyivsfuinanet eNl:fanae
il c 1yR<egCistrGatioI n q
oA1' LucUnC Nu mb er
111 Upony
Ad Expiration Dote
f 'qKq66
u relephuneSiga
ECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I e. ISL/ 2SC(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 ..........0 No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the subject property hereby
authorize to act on my behalf,in all matter
relative to work authorized by this building permit application.
Sigreaturcof0wiser Date
p —SE—CA iTION 7b: OWNERt OR AUTHORIZED AGENT DECLARATION
I A n e I t h- ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf. n —y—
Print Name
lo - Sr a � ib
. Wat of asner or Au(horizda Agem Date
(Sianall under the pains and penalties of 'u
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 ad have access to the arbitration
program or guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115,respectively.
�. 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 ()pen
). "Total Project Square Footage"may be substituted for'Tolal Project Cost"
g� CITY OF SALEM
PUBLIC PROPRERTY
o DEPARTMENT
-,I V I::NI I:Y:)x I it:r It 1,
�isn,a 1 WAsta Nc;ION STBEL-r * SAL EN41,MAS-SACIa it l ISO 197^�
978-745•9595 • P.sx:978.740--9S46
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
-litoylicaut Information Please Print Leeibly
Vamc lBusiixss Qrgannxrinn lndiv,duab: I H nZ I l r} n S�VU L 1 is LA
Address: IX q i— A!:Ae
CilyiStatcr/.ip: I� I'hune i:: 27� 74 (1 69 `��1
:,re you an employer? Check the appropriate box: 'Type of project(required):
- 4. Ela 6. ❑I m a general contractor and 1 New construction
I.❑ I am a employer with
tin to yces full untl/or am a sole proprietor or partner-art-time).•2.Vfjhave hired the sub-contractors
1 P y ( P listed on the attached sheet. 7• Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
I No workers'Gump. insurance 5. ❑ We are a corporation and its 10.eElectrical repairs or additions
required.) officers have exercised their
right of exemption per MGL 11.�'lumbing repairs or additions
3.❑ 1 ant a homeowner doing all work � S P P'
myself. LKo wprkcrs' ctnnp. C. 152,$1(4),and we have no 12.❑ Roof repairs
insurance required.j t employees. LKo workers' 13.❑ Other
comp. insurance ruquired.j
-Any jililvaia dwt cheeks box et must also till nut the section Wow showing lhvir worker compem�iolI policy intiunutiu2
i� 'I lam.owners who submit this af(davit indicating they are doing all rwrk and then him oulsidc cuntmetom must setmtil a new affdavil indiW mg ri
mtncmn that check this box must idxhod on additional..heet howi sng the name of tM sub comracwts and their ssurkera'comp.policy information.
-C,
/am an employer that it providing Ivorkers'c•ompenviuiun insurtutce fur»ry employees. Below is the policy and job.site
inforinution-
InsuranceCompany V;une: _—.__. .. . .._...---__----------
Policy 4 or Sclf-ins. Lice Expiration Date:
Job Site Address: -- Cityislate/Zip:
Attach at copy of the workers' compensation policy declaration page (showing; the policy number and expiration date).
Failure to oecure coverage as required under Section 25A ul':vIGL c. 152 can lead to the imposition of criminal penalties of a
line up to S 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 >_�
'2-0.00 it day tga• inst the violator. Ile advised that a copy of this statement may be furwarded to the Office of
Invcsugaunns ofthc [AA for insurance covera.-c verification.
/du hcrrhy ccrti uI er the p n an / naltics ofperjury that the information provided above is true and correct.
Sig':,:unto: _ _ Date: 16 - S- - 5LO I
ih
Ofjic•iul use ally. Do nor write in this area,to be completed by city or lows oJ%ic•ial.
City or fawn: _ _ Permit/License 9.-_
issuing.\uthorily(circle one):
I. Board of Ilcalth 2. Building Department 3. Cityi foss it Clerk 4. Llectrical Inspector 5, Plumbing; Inspector
G. OI[ter
Conrad 1'crsuu: -.. --- Phone Y:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their emmployees.
Pursuant to this swtn(e, an empluree is defined as "...every person in the service of another under any contract of hire,
cypress or implied, oral or written." a
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:ar 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."
NIGL chapter 152. v+'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. NIGL 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 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 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 (he 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.
I tic Otf Icc of Investigations would like to thank you in advance for your cooperation and should you lhavc 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
Offtce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE
Revised 5-26-05 Fax #617-727-7749
www.mass.gov/dia
Y UV JHLLIvt
PUBLIC PROPRERTY
DEPARTMENT
\I!II r • \\II \I,
III 'I.9 •li./:vi � I \C 'i'Y.�J}'15 JIB
Construction Debris Disposal .affidavit
(rC(luirCd li)r all dcmulition and renovation work)
In accordance \%ith the sixth edition of the State Building Code, 7S0 CA1R section 1 1 L5
Dcbris, and the provisions of .%1GL c 40, S 54;
Building Permit K _ is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal I•acility as defined by MGL c
I t 1. S 150A.
The debriswill be transported by:
/IG WLe 5�t'.0 CJ
(name of I%alllef)
I lie debris will be disposed of in
(uwnr of foci ity)
(addres.ul'1'�cllity)
aenauuc u(prm .Ippl caul
/a afa
,lal¢
Sep. 2. 2010 3: 19PM No. 2786 P. 2
i TWOP01321 Pogo No, of Pegee
Tanzella Construction
29 Eastern Avenue
Beverly, MA orgr5
Cell 978-766-og2g Fax 1-408-987-9403
PAOPOSALSUBMI'ITEDTO PHONE DATE
Frick Guzzo 8/ 201
STREET JOB NAME
23 Connant street• Kitchen & bath remodel
olry,STATE AND IIP CODE JOB LOCATION
Salem MA-01970
j ABOHITEOT DATE OF PViNB JOB PHONE
We hereby submit Apeoftilona and onUrnalaa''for. '
To rehab kitchen by removing all existing cabinets, counter tops, sink, plaster, ceiling and
insulation. Remove toilet, tub, sink, plaster and insulation from bath area...$1800.00
install new plumbing from 4' cast drain pipe in basement to kitchen and bathroom sinks,
tollet, tub, dishwasher and refridgerator...$5275.83
Install new electrical 200 amp, service panel with ground . Rewire complete kitchen to code.
Install 4 recessed telling lights in kitchen with dimmer and 3 under counter lights. Wire
bathroom exhaust fan (Panasonic type) with wall switches for fan and light...$6000.00
Install hardwood flooring in kitchen..32300.00 & the flooring In bathroom...$900.00
Insulate exterior walls of kitchen and bath...$600.00
Install new bathroom window...$1800.00 Plaster new walls and ceiling...$2150.00
Install kitchen cabinets and crown molding...$1789.00
i Appliance allowance...$5000.00 Fixture allowance...$3800.00
Lady's Dream granite counter top...$4705,55
Merillat cabinetry, Chiffon paint, silhouette style painted particle board...$7037.62
Remove tree from street side of home and clean yard of brush and debris-32992.00
Re-flash chimney and repair soffit and facia (up to 16')...$2400.00
Dump fee...$1000.00 Permit fee...$500.00
We*}ropOOC he ebytu Nmish metodat and lab or—pomptete In ercardanoe wdh lha above.apec gcallans,Icrth'4 eum ef:
Fifty thousand and fifty' daga a(S
Payment 10 a made aE fcllowE:
'All mgtedel le gdamftleedlA be epadgad.NI wo!k Io bA ram�lelatl Ina Ablhmizetl
workmanllke mpMar accordingg to afendarrQjpredttoee,An eteradon'or BlgBatwe '
davlgtlonfran g6ove apaolgaagdne InVoNlitq;aktradasls rAll be axoculatl
only upon wdttdnorders,and VP bedome an Wrd cttargedver the e6gmete.
All dgreaments donlingerlt upon stdkee,ooafdaAta or data(& eydnd'our NaLe:Thle proposal may ba
central.Owner to ogLZ ire dorngdo and ether nocassary nswanoe.qD wfthdrewn by ua If not eocoptod within dot's.
Acceptance
w�ar kern are fully covered 6y I`4odvnan'A compensagori Inswenca. _
'Accepta'nce 'o �ropoofll—TheEbovePrlcaa, Signatura ..
spacgieatlwa and cor dlllons are sailsfaclay and are hereby scooplad.You
era authorized to do the work as epeofilod. Payment 9d11 he made as ! ,
omllned.above. '
[(a� ,(1 Signature
Date of Aaepianae; ',� -
Hof C!on siliner Affim
y'�'Q ��
�nineit RegulatioB+
ME IMPROVEMENT CONTRACTOR '�g� '°�� vand fprdlvldul me Ong 'before the eWratfdn%te. 1f found return to f1 �
egistra 10 1,' 148019 011ice
Expiration -'.82V2011 dfConsumerA�fairs abd Business Regulaboli'
TrW 287374 16 Ysrk Plaka-Suite 3170
TYhe D8A Boston,.MA,02116 Y
TANZELLiA CONSTRUCTION
JOW TANLELIA l:
29 EASTERN AVE -
BEVERLY, MA 01915 — �
Uedeneerehrv:
i Not vilid iihOaSighature
'
i
M17ass ichustgts_ pelt trfrrit t tlf Public Safe ,
Bnaiyl o"Ifildi R I01i1:{ridn�
� t Construction Sti a �tfSfand:irds
g-� xLieen P NiSor Licebse"
h �• sp CS .86917 +,
Restrrcted to:, , z k
DD
JOHN V TANZELLq
29 EASTERN AVE
BEVERLY, MA 01915 "*