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3A DEWEY DR - BUILDING INSPECTION (2) JACKET The Commonwealth of Massachusetts W Department of Public Safety h10ssachusetts State Building Code(780CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) �— Building Permit Number: Date Applied: Building Official: O SECTION 1:LOCATION(Please indicate Block If and Lot#for locations for which a street address is not available) 'SA �e�v k B✓l 1 1.4 of r 70 I No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK I Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix t) Change of Use ❑ Change of Occupancy ❑ I Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an hidependentStructural Engincen. Pcmr Review required? �I Yes ❑ No ❑ Brief Description of Proposed Work: n 1ga E xu S�nn a h SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No,of Floors/Stories(include basement levels)&Area Per Fluor(sq.it.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a livable) A: Assembly A-I❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ - If: Hi h Hazard H-I❑. H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional F I ❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-I❑ R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a livable) IA ❑ IB ❑ HA ❑ HB ❑ IIIA ❑ IIIB ❑ I IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal:it Perm : Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicdte municipalus d❑ A trench will not be P s required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: %I,A I h t �Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or Nu❑ I Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): rype of Construction:_ Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stiptdatiuns: __ SECTION 9: PROPERTY OWNER AUTHORIZATION ' Name and Address of Property Owner N•��P�pt) (ct\4 jo%'tnd�n.�02N ( �CLt.. /Town 0Iq /Zia Pr' erty vn r Contact In( rmation: �[,�Q / - Title Telephone No.(business) Telephone No. (cell) a-nnaB address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,600 cu.ft.of enclosed space and/or not under Construction Control then check hen O and ski Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address - City/Town State Zip Discipline Expiration Date 10.2 General Contractor - - Coin nny Nam w ) Ke,Y, chfl o� �l Name of Person Itesponsible fur Cons[ coon License No- Type if Applicable SgCf,m.stort /�� /}: Pl,can 11A4 9/9'a Street Address City/Town State Zip V-711 "Ck C)o.cc t—t Tele hone No. business Telephone No. cell •J e-mail addres SECTION 11:W'OMEh4 COMPENSAI[ON INSURANCE AFFILMVIT M.G.L.c.152.S 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with-this application. Failure to provide this affidavit will result to the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ t. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical S appropriate municipal factor)_$ 3, Plumbing $ 4. Mechanical (HVAC) $ Note:Mininmm fee=$ (contact municipality) 5. Mechanical Other $ Enclose check ible to 6.Total Cost $ �� (contact nwnicipavalyity)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. E Ple.ue print and sign name Title Telephone No. Date V Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Dale Sep 23 15 08:32p p.1 The Commonwealth ofMassachusetls ! Department oflndustrialAccidents J1 I Congress Street, Suite 100 Boston,MA 01114-1017 www.massgov/dfa workers'Compensation IusuranceAffidavit:Builders/Contractors/Electriciaas/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information - Please Print Leeib)v Name(BusinesstOrgani=tionflndividmi): W 1I k",-4 Address: 54 ( e� �� �r i City/State/Zip: Phone if: ji Are yav ao employer?Check the appropriate box: Type of project(required): ].01 am a employer with employees(full andlor pan-Tim).• 7. []New construction 2.0I am a sole proprietor"partnership and have no employees wonting for me in 8. Q Remodeling any capacity.[No workers'wmp.insurance required] 9. 3.01 am a homeownerdoing ail work myself.[No workers'comp.ins" 1ance required.)t 0 Demolition 4.01 am sa a hootcowner d will be hiring corm conduct y property. ]will a im to ct all work onm 1 O 0 Building addition enure than all continams calla have workers'compensation insurance or are sole 11. Electrical repairs or additions propie1,Pe wish no employeCs. 12,❑Plumbing repairs or additions 5.01 are a general wnbactor and I have hired the svb-conratton 1"¢ttd on the attached sheet ]3.Q Roof rep these sub-cont kers raems have employees and have wor 'comp.insurxarxet 6.0 We an,a corparadm and is officers have exercised their right of exemption per MGL v. 14.0 Other 152,§1(4),and we have no employees.[No workers'camp inr"nace repuredJ *Any appiiead that checks box gl roan also tin ow the section below showing their workers'oempenatioo policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then him onside ro"nnors must submit a new aitidnit indicating such =Contractors that check this box must attached an additional shed showing the name ofthesub-coarneors and state wbettter"not those entities have employees Ifthamb-cmnct"s haveemployces,they tnnrtprevidc then workcrs'comp.potieynumba. I am an employer that isproviding workers'compensation insuraneefor my employees Below is thepeAry and job site Lrformadam fnsurance,Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: GSt)lStal&Mp: 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. 157,§25A is a criminal violation punishable by a fine up to 81.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to MOM a day against the violator.A copy of this statement may be forwarded to the Office oflovestigations of the DIA for insurance coverage verification. Ido hereby underthepains dpenahies ofperjuryytth�a�tthe information providedabove is true andeorrect Srplature L -'rare' Date ` �/ SlC N Phone#: O, tcial use only. Do not write in ibis area,to be compided by city or town ofj"ieial City or Town: PermittLicense# 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#: Sep 23 15 08:32p p.2 SECTION 9: PROPERTY OYYNEli A UTFIORIZATION Name and Address of Prnpurry Owner N,�(1 Ar t) �f�L ) IF 1 Na.�ind rcel Cit�•/'Eotvn O'q�C_� Pr rty cn r Contact Inf rmatimn:-� y 1 W J( a r"`�• Title Telephone No.(business) Tcicyhone No. (cell) e-mail address If applicable,the property owner herebv authorizes Name Street Address City/Town Stale Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit-1 lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin is less tt=35.000 cu.ft.of enclosed s ace and or not tm.ler Corehvclion Control then check here O and ski Section I0A 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. c-mail.nidrews Registration Number Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor Company Nam ; e �.. Name of Person Respo n si ble for Constr .ction License No. Ad Yype if Applicable Street Address City/Town State Zip 'L_ ' ✓� .1 t., if A Telephone No business Telephone No, cell ` e-moil addms.4' SECTION 11:lvtn:r:El:S't:CmurEN5A IIC?N•INSURANC'I.iu'F11i'MI M.G.L.c.152. 25C6 A Workers'Compensation Insurance Affidavit from the NIA Depvtment of Industrial Accidents must be completed and submitied with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Isasigned Affidavit submitted with thisa licarion? Yes[I No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor nod Materials) 'total Construction Cum(from Item 6)=5 I 0utlding $ Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical 5 appropriate municipal factor)=$ 3. Plumbing 5 . I.Mechanical (HVAC) S Nute:Minimum nn fee a g ( uact municipality) 5.Mechanical Other S Enclose check payable to 6.Total Cost S ,;OU (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 0y. entering no,name below.I hereby attest under the pains and penalties of perjury that all of the information contained in this .application is true and accur:ne tto)the best of my knowledge and understanding. ' :CzN �� .'stoF\... y,,t �%ltrla,Ntal,•�>� �- o:�r�v� -��i _LSLr. a57Y 9r�stf.� !l1£ Please print and sign name Title r� Telephone No. Date 1 'J ;:,.I rr1-- y-'GC I 61 Y C 3 Street Address City/Town Stale Zip d luaicipal Inspector to fill out this section upon application app rov a h. \Score Date i American Properties Team, Inc. i I TO: 3A Dewey Drive FROM: Jennifer Pappas, Property Manager RE: Deck Replacement/Repairs DATE: September 14,2015 Please be advised that the Board of Trustees for Pickman Park has approved the replacement (and/or repairs)of your deck at the above referenced unit. This approval is contingent upon it matching the existing deck in size/construction. Composite materials can be used. The Board will not allow any other design alterations. In addition,the deck must be built in accordance with the attached specifications and all drawings that were provided. We also require that permits be pulled in advance(regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information, please feel free to call me directly at(781) 569-2675. cc: Unit File 500WEST CUMMINGS PARK-SUITE 6050- W06URN -MA-01801.781-932-9229 -FAX 781-935-4289 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT KosasatsY tra,scat MAYOR IM WASH24T sNSTRW 9 SAT VIA MAUACHLWM01970 Tzu M745.9595 a FAxa 97s,74o.9W Workers' Compensation Insurance Atlidav[tt BnIIdera/ContnctorsMecMetans/Plumben Applicant_Informadon Cennfrun4inni Specialties _ Please Isrtnt F roilchr Name P.O. Box 53 Address: Stoneha!at MA; OHM City/State/Zip: Phone# _ g — to 5— L Any ■an smpleyW?Cheek the appropriate boss requitro I.Q I am a employer with__ 4, Q I am a gewd eonnactor and 1 Type�pro1�( ): employees(fall and/or part-time).* have hired the sub•contracma 6• ❑New construction 2.Q I am a sole proprietor or prima-• lined an the attached sheet.t 7. ❑Remodeling ship and have no emplaym Those have S. Q Demolition working for me in any capacity. works=#comp,iunvance, [No workers'comp,insurance 5. Q We are a corporation and its 9. Q Building ro9�dl o8ice�s have exercised their 30.0 Electrical repair or additions 3.Q J ems homeowner doing all work right of exmnption.per MOL L13 1.Q Plumbing repaiis as additions myself.[No workers'comp. o. 152.11(4).and we have no .Q f insurance nqd 1 t emphuYea [No workan• 99 comp,inattattcs regnirdd j . let i �OLti -Any oVVHe"dat dwda box#1 max am ett sue she+«da s bdow dforiea ask weekms' Y°•tY tedcrostlaa HomeoWe 0%towbron�Yir.Alervtrfuafutleadj andobaa_�ddwhi GOO& bamwomcsnutau6ksDearstddavte -Cankers der Cheek dds bma mug mechd oa addtdmul.hit dwwiug er a®e of dw cad erir wades' hdbn nua L . I aiw orms a employer-hat lrprov/dLsj waiters'eomp"asdoa buumneejormy employ"A Below!s the injordaw, � policy andJob rW Insun=d Company Name Policy#or Self-his.Lic.iW W L�i �(0 Zb(o()(o c� AA pp�� Expiration Date- I� v8 {� Attach a COPYsa: be workers' City/Staw0p `�'r i M © 1C�7o Attach a copy of'be rrorlran'compeaaatlon policy deelandon pap(showingthe Failure w secure covara as paltry camber and explratlon dsd� ge required under Section 25A of MOL 0. 152'can lead to the impoddon of crimhW penalties of s fine up to 31,500.00 and/or one-year imprisonment,as won o u civil penalties in she terra Oft s STOP WORK ORDER and a fine of up to 5250.00 s day apinat the violates Be advised that A copy of this statement may be forwarded to the Onjes of Investigations of the DIA for insurance coverage verUication. do hereby cardffjr ender the p ared penaldes ojper/ery dial the Injormaalon provided love 4lrrrt correct Signature: Phone#: �R, fv 6 S - 4 q O,(jle'a'rrsi omit Do not writs In Ab area,to be Completed by dq,orloww of C14 City or Town: Pernat/Lieea"/ Issuing Authority(circle one): I. Board of Hesith 2.Building Department 3.Cityfrown Clerk 6.Other 4,Electrical Inspector S.Plumbing IInspector Contact Person: Phone#: Crnt OF SAt.EM ' PUBLIC PROPERTY DEPARTMENT MOM �aswsa�a�rsemtar�s4.eoayosotfl� t��►ts.esss•�,�,s+�s�+►ew conwwda. Debrb Dblmd Mwsvtt 621dummadomadmmad we" is.eeo�a.eos witk�>isrti.ditJos attbsse.e. �Aso cx�at seetto�tit.! Debdq ed tAs psovtsioms at3iGL s�4'�1 a Jt•+nit r is Ism"via aw sommom"dw&b&mmum*fte cMs aio�!abap As dtsDoW o[bt s D�'o�b►Neessi�rw dteposet AdHgt>.dsdad by tIit3.• 'Ris dells wiL bs traa�po�tsd byt - w•e� Tiw dells will be disposed slim: c�Ja�.a at�u4» 1 alton i 00-35,000 cf enclosed space I - (MGL CA 12 S.60L) � 1A-Masonry only 1 G-1 &2 Family Homes i ; failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. i r DIG SAFE CALL CENTER: (888).3444233 t a BOARD OF•BU"I�DING REGULATIONS License: CONSTRUCTION SUPERVISOk2' -q. Number. CS 05389Z 'z, BlrtMdate 0 540 271 96 2 Expires 05/02/2007 �Tr no: 72207 f ResUicted 00 TIMOTHY J FINN. t 8 VALDORA DR/PO BOX STONEHAM, MA 021�60 Co misslo ` . I AUG-28-2007 06 :25 AM SURDAM 978 499 8789 - eta , � 1gi � 3 , 1R30 PROPOSAL P CONSTRUCTION SPECIALTIES UNLTO.,INC. P.O.BOX 53 STONEHAM,MA 02180 Phone(781)66S-d+{10 Fox(781) 665-4411 E NOX BROAN-NUTONE HEARTH PRODF A NORTEK COMPANY a.�Et D � �r_ ( arc,o Ptwf6- v,re_ a- cQZsP'DLC- one cQ�vv cd1 Can netl P''°e- ( +ex-vm,`nda`)bn c!ae 1 me-e-o Ajoftnr , oyc �vrnea"l �,�e- as We propose hereby to furnish material and labor- complete in accordance with the above specifications for the sum of: AS ABOVE Payment to be made as follows: For sPecial orders a 50%deposit is required. For central vacuum and intercom installation,half is due upon rough-in and half is due upon completion. For all other work,p ent is due upon job completion. Authorized Signature NOTE : All plumbing hook-ups, carpentry work& building permits are the responsibility of the job site general contractor or homeowner. Prices are effective for up to 3 months from date of proposal. Acceptance of Proposal T��^W PbY.,p.dEmtlwu YEamdWw.n,.tl.BoO'y.YG Y11NNy YOlpltl Fw mM6eehY rodO YM MOIi[.-.pogl.l iymoptwWba'IO.Y WtlIO,E,bON signature Date: If accepted please sign and reWra. EITStOF - PUBLIC PROPERTY DEPARTMENT KI%SFYLM DRISCULL YUL'l<.%L%MAUIL36l�t 01970 113t:M745.9S"9 FA=M7404" (FOR THE REPAIR. RENOVATION, CONSTRUCTION, D&MOLM—OM OR CHANGE OF USE OR OCCUPANCY FOR ANY E%IST<riC,j STRUCTURE OR MILUMNG- 1.0 SITE INFORMATION location Name: t i c_L r n o A O-r Building: Property is located in a:Conservation Arse YM HWkWc Dbtrict Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: S4tMYA&q -Fakartm Address: 3A- el-0 Dt. Telephone: 'Zk' `i— q'Z 3.0 COMPLETE THIS SECTION FOR WORK IN EIlS M BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use NOW Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: RcmoJc- �C0.�emct-CD YB�'CkLe fl\De `F �%- Me- 6,.l"S . mall Norco �,,pel, I o - - MailPermitto: use of the Bu What is the current i►oing?� Material of Building? ���6 Q& If dwelling.how many units?-4 WIN the Building Conform to Law? Asbestos? AwAdU Ys Name Address and Phan ( ) MedmuWs Name %\^k IY✓� ar�YP �� Zgl —�o�S-�� Address and Phone Lkp(o � Supervisors License is Cs50$39' 1 HIC ReglWstIw Estimated Cost O`ff�PrrojI�ed S Pom*Fee Calculatlon � Permit Fee S��-- Estimated Cost X$7/51000 Residential Es*nated Cost X S411$1000 Comnwclat----------- - An Additional$5.00 is added as an Administrative charge. Make sure that all flekis are properly and legibly written to avoid delays in processing. The underalgned does hereby apply for a Building Permit to build to the above stated specftatkms. Signed under penalty of perjury Date I �� of ` N o E- a � a � C4�7 � `3 �i V 06